Multiples Interventions and Risk in the Elderly Population
In the frail and elderly population referred for LAAC, patients harbor
several cardiac and extracardiac comorbidities (23). This clinical
status leads to both: 1. higher risk of requiring multiple cardiac
interventions; and 2. higher risk of complications when these cardiac
interventions are performed. Moreover, multiple, and repeated
hospitalizations and anesthesia in the elderly population can result in
periprocedural complications unrelated to the initial clinical condition
that prompted the admission or to the procedure itself (24). Thus, a
strategy combining LAAC and another cardiac structural or
electrophysiological intervention in a single intervention appears
attractive. In fact, the combined strategy may decrease hospitalizations
and the length of stay and will require only one anesthesia/sedation. On
the other hand, due to physiological and pathological changes that occur
with age, patients maybe at higher risk of periprocedural morbidity and
mortality (25,26). Thus, the combined strategy had to be studied to
demonstrate equal or even superior benefits in term of efficacy and
safety. In our small cohort, despite similar baseline characteristics,
the rates of technical and procedural success and periprocedural
complications were not different in patients who underwent the combined
strategy compared to those who underwent the single LAAC. These results
strengthen the feasibility and safety of the concomitant approach
previously described in the Swiss series using the
AmplatzerTM devices (16).